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Nguyen L, Dierckxsens C, Kerscher M, Hartjen A, Schneider SW, Herberger K. Rosacea treatment with 532 nm KTP versus 595 nm pulsed dye laser-A prospective, controlled study. J Cosmet Dermatol 2024; 23:2443-2449. [PMID: 38600654 DOI: 10.1111/jocd.16300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/12/2024] [Accepted: 03/14/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Pulsed-dye lasers (PDL) are one of the standard therapies for rosacea, but alternatives are needed. AIMS To compare the efficacy and safety of the variable-sequenced, large-spot 532 nm KTP laser to the 595 nm PDL in treating rosacea. MATERIALS AND METHODS A prospective, controlled, evaluator-blinded study. Patients were treated with either a KTP or PDL with 1-3 sessions at intervals of 6-8 weeks. A follow-up visit was scheduled on Week 6 post-treatment. Clinical outcome was assessed by computer-assisted analysis and by patients and two blinded dermatologists. Pain intensity during treatment and adverse events were documented. RESULTS Forty-five patients (mean age 51 years) were allocated in a 2:1 ratio to either the KTP or PDL. Erythema in both treatment arms decreased significantly (p < 0.01). Clinical evaluation revealed high improvement. Mean pain intensity was significantly lower with the KTP (2.5/10) than with the PDL (4.1/10). Both lasers showed a good safety profile. Relevant purpura was only seen in the PDL group. CONCLUSIONS Both the variable-sequenced, large-spot KTP and the PDL demonstrated comparable efficacy in treatment of rosacea. Regarding safety, the KTP exhibited fewer post-treatment reactions. The KTP might serve as a potential alternative to PDL in the treatment of rosacea.
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Affiliation(s)
- Lynhda Nguyen
- Laser Department, Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Martina Kerscher
- Division of Cosmetic Sciences, Department of Chemistry, University of Hamburg, Hamburg, Germany
| | - Anna Hartjen
- Laser Department, Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan W Schneider
- Department of Dermatology und Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katharina Herberger
- Laser Department, Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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2
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Nguyen L, Seeber N, Kautz G, Hartjen A, Schneider SW, Herberger K. 532-nm potassium titanyl-phosphate laser versus 595-nm pulsed dye laser for port-wine birthmarks: A prospective, randomized, split-side study. J Eur Acad Dermatol Venereol 2024; 38:1140-1146. [PMID: 38794945 DOI: 10.1111/jdv.19750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/24/2023] [Indexed: 05/26/2024]
Abstract
BACKGROUND Pulsed dye lasers (PDL) are currently the first-line treatment of port-wine birthmarks (PWB). Due to high maintenance costs and instable technology, alternative methods are needed. OBJECTIVES To compare clinical outcomes of a variable-sequenced, long-pulsed 532-nm potassium titanyl-phosphate (KTP) laser and PDL on treating PWB. METHODS A prospective, randomized, split-side study. Patients were treated with a KTP laser and PDL with 1 to 5 sessions at intervals of 6-8 weeks. A follow-up visit was scheduled 6 weeks post-treatment. Efficacy was evaluated through colorimetric analysis, area reduction measurements and clinical evaluations by two blinded investigators based on photo documentation. Subjects provided rating of pain intensity during treatment, post-treatment reactions and satisfaction. Safety was measured by adverse events. Maintenance issues of the laser systems were documented. RESULTS A total of 35 patients (mean age 42.1 years) were enrolled. 63% were female. Patients received 2.4 (SD 1.4; 1-5) treatment sessions. Colorimetric analysis indicated a comparable clearance effect in PWB of both KTP laser and PDL. Independent investigators rated clinical appearance to be significantly improved compared to baseline. No significant difference was observed between both laser systems. Regarding post-treatment reactions, the KTP laser caused less swelling, purpura and crusts. 96% would recommend both treatment modalities. Patients were satisfied with both laser systems. During the study, PDL systems malfunctioned for 6.6 months in total. For the KTP laser, we did not observe any system failures. CONCLUSION Our data indicate that the KTP laser of the latest generation with large-spot sizes, subpulse technology and cryogen cooling has a comparable efficacy to the PDL in treating PWB. In addition, KTP laser is associated with greater tolerability, fewer technical failures and lower repair costs. Further prospective studies are required to determine the true effectiveness of the KTP laser in PWB treatment. This study was preregistered in Clinicaltrials.gov (NCT05771298).
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Affiliation(s)
- Lynhda Nguyen
- Laser Department, Department for Dermatology und Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nikolaus Seeber
- Joint Practice for Dermatology Dres. Peter/Seeber/Altheide, Hamburg, Germany
| | - Gerd Kautz
- Skin and Laser Clinic Dr. Kautz, Konz, Germany
| | - Anna Hartjen
- Laser Department, Department for Dermatology und Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan W Schneider
- Department for Dermatology und Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katharina Herberger
- Laser Department, Department for Dermatology und Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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3
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Sharma A, Kroumpouzos G, Kassir M, Galadari H, Goren A, Grabbe S, Goldust M. Rosacea Management: A Comprehensive Review. J Cosmet Dermatol 2022; 21:1895-1904. [PMID: 35104917 DOI: 10.1111/jocd.14816] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/11/2022] [Indexed: 11/28/2022]
Abstract
Rosacea is a chronic cutaneous disorder affecting primarily the face, characterized by erythema, transient or persistent, telangiectasia, and inflammatory lesions including papulo-pustules and swelling. The essential component of the disease is the persistent erythema of facial skin. Episodes of flushing (acute-subacute intermittent vasodilation) are common. Swelling and erythema of the nose along with dilatation of the pilosebaceous poral orifices, known as rhinophyma, can be noted in chronic cases. Rosacea affects up to 10% of the world population and is especially noted in fair skinned individuals aged 35 to 50. Women are affected more often than men. Several treatment modalities including topical medications, systemic drugs, lasers and light-based therapies have been used for the management of rosacea with variable results. Topical medications such as azelaic acid, metronidazole, and sulfacetamide/sulphur, oral antibiotics such as tetracyclines, and oral retinoids alone or, most commonly, in combination form the mainstay of treatment. Light therapies such as intense pulsed light and pulsed dye laser are best used for the eythemato-telangiectatic type. Topical brimonidine, oxymetazoline, ivermectin, tacrolimus, pimercrolimus, low-dose modified release tetracyclines and botulinum toxin are the new additions to the therapeutic armamentarium. This article provides a comprehensive review of the various therapies used for rosacea.
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Affiliation(s)
- Anuj Sharma
- Department of Dermatology, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Himachal Pradesh, Kangra (Tanda), India
| | - George Kroumpouzos
- Department of Dermatology, Alpert Medical School of Brown University Providence, Rhode Island, Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil.,GK Dermatology, PC, South Weymouth, Massachusetts, USA
| | - Martin Kassir
- Founding director, Worldwide laser institute, Dallas, USA
| | - Hassan Galadari
- College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Andy Goren
- Applied Biology, Inc, Irvine, CA, United States
| | - Stephan Grabbe
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Mohamad Goldust
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
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4
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Cheon JH, Hwang YJ, Yoon ES, Jung KY, Park SH, Chung JH. Effectiveness of a combination therapy using non-ablative fractional laser and intralesional triamcinolone injection for thyroidectomy scar treatment: a prospective, randomized, blinded pilot study. J Cosmet Dermatol 2021; 21:2793-2800. [PMID: 34582088 DOI: 10.1111/jocd.14485] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/17/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The occurrence of thyroid cancer has increased dramatically, and postoperative scars are placed at easily visible locations. Many patients show stronger desire for scar prevention. So far, numerous approaches have been discussed for the treatment of scars; this study is conducted to verify whether the early application of combined therapy contributes to minimal scar formation. METHODS Between March 2019 and December 2019, total of 64 patients with thyroidectomy scars of a size greater than 4.5 cm located on the anterior neck were enrolled in this prospective pilot study. Subjective and objective evaluation were carried out using the Patient and Observer Scar Assessment Scale (POSAS) at one, two, and six months after operation. Results were compared between a treatment group and a non-treatment group. RESULTS In PSAS score, the mean values of pain, itching sensation, pliability, thickness, and relief were significantly higher in the laser and steroid treatment group (p = 0.009, p = 0.000, p = 0.013, p = 0.002, and p = 0.007). The value of color of the scars showed no significant differences (p = 0.504). In OSAS score, parameter of thickness, relief, and surface area score was significantly higher score in the combination group (p = 0.029, 0.035, and 0.020), while vascularity, pigmentation, and pliability were not significantly different between two groups (p = 0.548, p = 0.983, and p = 0.128). CONCLUSION This study demonstrates that early combination therapy contributes to scar improvement to a meaningful extent based on POSAS. We believe that the combined therapy has a synergy effect on scar management, which improves the patients' quality of life in relation to their postoperative scars.
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Affiliation(s)
- Jeong Hyun Cheon
- Department of Plastic and Reconstructive Surgery, Korea University College Medicine, Seoul, Korea
| | - Yong Jae Hwang
- Department of Plastic and Reconstructive Surgery, Korea University College Medicine, Seoul, Korea
| | - Eul Sik Yoon
- Department of Plastic and Reconstructive Surgery, Korea University College Medicine, Seoul, Korea
| | - Kwang Yoon Jung
- Department of Otorhinolaryngology-Head and Neck, Korea University College Medicine, Seoul, Korea
| | - Seung-Ha Park
- Department of Plastic and Reconstructive Surgery, Korea University College Medicine, Seoul, Korea
| | - Jae Ho Chung
- Department of Plastic and Reconstructive Surgery, Korea University College Medicine, Seoul, Korea
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5
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Yepuri V, Patil AD, Fritz K, Salavastru C, Kroumpouzos G, Nisticò SP, Piccolo D, Sadek A, Badawi A, Kassir M, Gold MH, Große-Büning S, Grabbe S, Goldust M. Light-Based Devices for the Treatment of Facial Erythema and Telangiectasia. Dermatol Ther (Heidelb) 2021; 11:1879-1887. [PMID: 34562267 PMCID: PMC8611125 DOI: 10.1007/s13555-021-00607-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Indexed: 10/26/2022] Open
Abstract
Facial erythema is one of the most common outpatient complaints in dermatology. There are various causes of facial erythema and several devices are available for its treatment. Pulsed dye laser (PDL) and intense pulsed light (IPL) are the two common light devices used for these conditions. In this review, we evaluated the literature to assess efficacy of IPL versus PDL in facial erythema and telangiectasia. We searched published articles including clinical trials or reviews articles, case series, and case reports. Electronic databases (MEDLINE and PubMed) were searched to retrieve the articles. Reference lists of selected articles were also considered for the review. Articles published in English language until June 2021 were considered for this review.
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Affiliation(s)
- Vani Yepuri
- Venkat Charmalaya, Centre for Advanced Dermatology and Post Graduate Training, Bangalore, Karnataka, India
| | - Anant D Patil
- Department of Pharmacology, Dr. DY Patil Medical College, Navi Mumbai, India
| | - Klaus Fritz
- Dermatology and Laser Center, Reduitstr. 13, 76829, Landau, Germany.,"Carol Davila" University of Medicine and Pharmacy, 37 Dionisie Lupu Str, 020021, Bucharest, Romania
| | - Carmen Salavastru
- "Carol Davila" University of Medicine and Pharmacy, 37 Dionisie Lupu Str, 020021, Bucharest, Romania.,"Colentina" Clinical Hospital, Pediatric Dermatology Discipline, Dermato-Oncology Research Facility, 19-21 Stefan cel Mare Str, Bucharest, Romania
| | - George Kroumpouzos
- Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode, Island.,Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil.,GK Dermatology, PC, South Weymouth, Massachusetts, USA
| | - Steven Paul Nisticò
- Dermatology Unit, Department of Health Sciences, Magna Graecia University of Catanzaro, 88100, Catanzaro, Italy
| | | | - Ahmed Sadek
- Cairo Hospital for Dermatology and Venereology (Al-Haud Al-Marsoud) Manager, Cairo, Egypt
| | - Ashraf Badawi
- Medical Laser Applications, National Institute of Laser Enhanced Sciences, Cairo University, Giza, Egypt.,Dermatology and Allergology Department, Faculty of Medicine, Szeged University, Szeged, Hungary.,, Oakville, Canada
| | | | - Michael H Gold
- Gold Skin Care Center, Tennessee Clinical Research Center, Nashville, TN, USA
| | | | - Stephan Grabbe
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Mohamad Goldust
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany.
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6
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Husein-ElAhmed H, Steinhoff M. Laser and light-based therapies in the management of rosacea: an updated systematic review. Lasers Med Sci 2021; 36:1151-1160. [PMID: 33389310 DOI: 10.1007/s10103-020-03200-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/13/2020] [Indexed: 01/08/2023]
Abstract
Unlike other rosacea therapies which need daily takings or applications over long periods, the edge of lasers and light-based therapies (LLBT) is the limited number of sessions to achieve improvement. The proper selection of the adequate physical device in accordance with the patients' skin features and rosacea-related signs and symptoms should be considered and the management with physical sources should be updated as new data become available. This article reviews and discusses the current use of lasers and light-based therapies in rosacea with reference to all the available literature.This systematic review demonstrates the quality of evidence to support any recommendation on LLBT in rosacea is low-to-moderate. Among all the available devices, PDL holds the most robust evidence. Treatments options should be tailored for each specific clinical scenario as it is unlike that single modality results in complete resolution. Platforms that include two or more devices and combined therapies with topical agents are suitable and they warrant further investigations.
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Affiliation(s)
- Husein Husein-ElAhmed
- Department of Dermatology and Venereology, Hospital de Baza, Granada, Spain. .,Translational Research Institute, Hamad Medical Corporation, Doha, Qatar.
| | - Martin Steinhoff
- Translational Research Institute, Hamad Medical Corporation, Doha, Qatar. .,Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar. .,College of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar. .,Medical School, Qatar University, Doha, Qatar. .,Department of Dermatology, Weill Cornell Medicine, New York, NY, USA.
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7
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Oliveira CMMD, Almeida LMC, Bonamigo RR, Lima CWGD, Bagatin E. Consensus on the therapeutic management of rosacea - Brazilian Society of Dermatology. An Bras Dermatol 2020; 95 Suppl 1:53-69. [PMID: 33172727 PMCID: PMC7772594 DOI: 10.1016/j.abd.2020.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/14/2020] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Rosacea is a chronic inflammatory disease of the skin, relatively more frequent in women over 30 with a low phototype and proven genetic predisposition. Although its etiology is unknown and possibly multifactorial, the immunological abnormality, associated with neurovascular dysregulation and triggering factors, are important elements in its pathophysiology, which lead to the main changes of inflammation, vasodilation, and angiogenesis that are responsible for the clinical manifestations. Despite the lack of cure, numerous therapeutic options are available for the different clinical presentations of the disease, with satisfactory responses. OBJECTIVE To reach a consensus, with recommendations from experts, on the therapeutic management of rosacea suitable to the Brazilian setting. METHODS The study was conducted by five specialized dermatologists from university centers, representatives of the different Brazilian regions, with experience in rosacea, who were appointed by the Brazilian Society of Dermatology. Based on the adapted DELPHI methodology, the experts contributed through an updated bibliographic review of the scientific evidence, combined with personal experiences. RESULTS The group of experts reached a consensus on the relevant aspects in the therapeutic management of rosacea, providing information on epidemiology, pathophysiology, triggering factors, clinical condition, classification, quality of life, and comorbidities. Consensus was defined as approval by at least 90% of the panel. CONCLUSION Despite the impossibility of cure, there are several therapeutic alternatives specific to each patient that provide excellent results, with chances of total improvement and long periods of remission, promoting a positive impact on quality of life. This consensus provides detailed guidance for clinical practice and therapeutic decisions in rosacea.
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Affiliation(s)
| | - Luiz Mauricio Costa Almeida
- Department of Dermatology, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, MG, Brazil; Dermatology Service, Santa Casa de Misericórdia de Belo Horizonte, Belo Horizonte, MG, Brazil
| | - Renan Rangel Bonamigo
- Dermatology Service, Hospital das Clínicas de Porto Alegre, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Ediléia Bagatin
- Department of Dermatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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8
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Nam CH, Kim MH, Hong SP, Park BC. Fractional 532‐nm KTP diode laser and 595‐nm pulsed dye laser in treatment of facial telangiectatic erythema. J Cosmet Dermatol 2018; 18:783-787. [DOI: 10.1111/jocd.12692] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Chan Hee Nam
- Department of Dermatology, College of Medicine Dankook University Cheonan Korea
| | - Myung Hwa Kim
- Department of Dermatology, College of Medicine Dankook University Cheonan Korea
| | - Seung Phil Hong
- Department of Dermatology, College of Medicine Dankook University Cheonan Korea
| | - Byung Cheol Park
- Department of Dermatology, College of Medicine Dankook University Cheonan Korea
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9
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LaRosa C, Chiaravalloti A, Jinna S, Berger W, Finch J. Laser treatment of medical skin disease in women. Int J Womens Dermatol 2017; 3:131-139. [PMID: 28831422 PMCID: PMC5555278 DOI: 10.1016/j.ijwd.2017.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 05/09/2017] [Accepted: 05/09/2017] [Indexed: 01/01/2023] Open
Abstract
Laser treatment is a relatively new and increasingly popular modality for the treatment of many dermatologic conditions. A number of conditions that predominantly occur in women and that have a paucity of effective treatments include rosacea, connective tissue disease, melasma, nevus of Ota, lichen sclerosus (LS), notalgia paresthetica and macular amyloidosis, and syringomas. Laser therapy is an important option for the treatment of patients with these conditions. This article will review the body of literature that exists for the laser treatment of women with these medical conditions.
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Affiliation(s)
- C. LaRosa
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT
| | - A. Chiaravalloti
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT
| | - S. Jinna
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT
| | - W. Berger
- Frank H. Netter MD School of Medicine, Quinnipiac University, North, Haven, CT
| | - J. Finch
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT
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10
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Papaspyrou G, Schick B, Al Kadah B. Nd:YAG Laser Treatment for Extranasal Telangiectasias: A Retrospective Analysis of 38 Patients with Hereditary Hemorrhagic Telangiectasia and Review of the Literature. ORL J Otorhinolaryngol Relat Spec 2016; 78:245-251. [PMID: 27486666 DOI: 10.1159/000447949] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 06/21/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Extranasal telangiectasias are common amongst hereditary hemorrhagic telangiectasia (HHT) patients. Telangiectasias can be found at sites like the external nose, lips, oral cavity and fingers. Although not life threatening, they can be annoying for patients and lead to bleeding in some cases, necessitating treatment. METHODS The data of 38 HHT patients treated for extranasal telangiectasias during a period of 10 years by means of Nd:YAG laser were retrospectively analyzed. RESULTS The telangiectasias treated affected predominantly the tongue, facial skin and lips. During a minimum follow-up of 3 years, only 7 patients required a revision of surgery. CONCLUSION This study shows that Nd:YAG laser constitutes a fast, safe and efficient therapeutic modality for the treatment of extranasal telangiectasias.
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Affiliation(s)
- Giorgos Papaspyrou
- Department of Otorhinolaryngology, University Medical Centre Homburg/Saar, Homburg/Saar, Germany
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11
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Abstract
Laser dermatology is an ever-expanding part of the specialty used extensively for both aesthetic and medical conditions. Advances in laser technology have led to an expansion in the number of devices available, with as a consequence an increase in the total number of complications. Fortunately, the current technology has improved greatly which adds to the safety profile of such devices; nevertheless, thorough knowledge of laser complications and how to avoid them is paramount for any practitioner who uses such technology.
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12
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Abstract
Refining diagnostic criteria has identified key characteristics differentiating rosacea, a chronic skin disorder, from other common cutaneous inflammatory conditions. The current classification system developed by the National Rosacea Society Expert Committee consists of erythematotelangiectatic, papulopustular, phymatous, and ocular subtypes. Each subtype stands as a unique entity among a spectrum, with characteristic symptoms and physical findings, along with an intricate pathophysiology. The main treatment modalities for rosacea include topical, systemic, laser, and light therapies. Topical brimonidine tartrate gel and calcineurin inhibitors are at the forefront of topical therapies, alone or in combination with traditional therapies such as topical metronidazole or azelaic acid and oral tetracyclines or isotretinoin. Vascular laser and intense pulsed light therapies are beneficial for the erythema and telangiectasia, as well as the symptoms (itching, burning, pain, stinging, swelling) of rosacea. Injectable botulinum toxin, topical ivermectin, and microsecond long-pulsed neodymium-yttrium aluminum garnet laser are emerging therapies that may prove to be extremely beneficial in the future. Once a debilitating disorder, rosacea has become a well known and manageable entity in the setting of numerous emerging therapeutic options. Herein, we describe the treatments currently available and give our opinions regarding emerging and combination therapies.
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Affiliation(s)
- Allison P Weinkle
- School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Vladyslava Doktor
- Dermatology Department, St John's Episcopal Hospital, Queens, NY, USA
| | - Jason Emer
- Spalding Drive Plastic Surgery and Dermatology, Beverly Hills, CA, USA
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13
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Kazandjieva J, Tsankov N, Pramatarov K. The red face revisited: Connective tissue disorders. Clin Dermatol 2014; 32:153-8. [DOI: 10.1016/j.clindermatol.2013.05.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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15
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Ganceviciene R, Liakou AI, Theodoridis A, Makrantonaki E, Zouboulis CC. Skin anti-aging strategies. DERMATO-ENDOCRINOLOGY 2012; 4:308-19. [PMID: 23467476 PMCID: PMC3583892 DOI: 10.4161/derm.22804] [Citation(s) in RCA: 376] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Skin aging is a complex biological process influenced by a combination of endogenous or intrinsic and exogenous or extrinsic factors. Because of the fact that skin health and beauty is considered one of the principal factors representing overall "well-being" and the perception of "health" in humans, several anti-aging strategies have been developed during the last years. It is the intention of this article to review the most important anti-aging strategies that dermatologists have nowadays in hand, including including preventive measurements, cosmetological strategies, topical and systemic therapeutic agents and invasive procedures.
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Affiliation(s)
- Ruta Ganceviciene
- Centre of Dermatovenereology; Vilnius University Hospital Santariskiu Klinikos; Vilnius, Lithuania
| | - Aikaterini I. Liakou
- Departments of Dermatology, Venereology, Allergology and Immunology; Dessau Medical Center; Dessau, Germany
| | - Athanasios Theodoridis
- Departments of Dermatology, Venereology, Allergology and Immunology; Dessau Medical Center; Dessau, Germany
| | - Evgenia Makrantonaki
- Departments of Dermatology, Venereology, Allergology and Immunology; Dessau Medical Center; Dessau, Germany
| | - Christos C. Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology; Dessau Medical Center; Dessau, Germany
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16
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17
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Alam M, Olson JM, Asgari MM. Needs Assessment for Cosmetic Dermatologic Surgery. Dermatol Clin 2012; 30:177-87, x. [DOI: 10.1016/j.det.2011.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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18
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Abstract
Patients frequently seek treatment of cutaneous vascular lesions for both medical and cosmetic reasons. Advances in the use of lasers and light sources enable physicians to effectively treat vascular lesions that were previously untreatable. Given the plethora of devices available, selecting the appropriate laser system and treatment parameters can be confusing for the laser surgeon. This article reviews current concepts in the treatment of adult vascular conditions. It highlights the different types of lasers and the most common vascular lesions amenable to therapy. Also, the article offers several pearls regarding selection of the laser and of the treatment parameters.
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Affiliation(s)
- Tomi L Wall
- Department of Dermatology, Wellman Laboratories of Photomedicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
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Kim TG, Roh HJ, Cho SB, Lee JH, Lee SJ, Oh SH. Enhancing effect of pretreatment with topical niacin in the treatment of rosacea-associated erythema by 585-nm pulsed dye laser in Koreans: a randomized, prospective, split-face trial. Br J Dermatol 2011; 164:573-9. [PMID: 21143465 DOI: 10.1111/j.1365-2133.2010.10174.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Rosacea is a chronic dermatosis that is usually confined to the face. A pulsed dye laser (PDL) system has been proven to be effective in treating rosacea-associated erythema and telangiectasias. Niacin is a cutaneous vasodilator that can increase the chromophore through increased blood flow. OBJECTIVES We hypothesized that increased blood flow by pretreatment with topical niacin could enhance the effect of PDL in the treatment of rosacea. METHODS Eighteen Korean patients with rosacea were recruited. Three sessions of 585-nm PDL using a subpurpuragenic dose with and without pretreatment with niacin cream were performed on randomly assigned half-faces at 3-week intervals. Erythema was assessed objectively by a polarization colour imaging system, and evaluations were also made by three blinded dermatologists. Patient satisfaction was evaluated using a 10-point visual analogue scale. RESULTS Fifteen patients completed this study. All patients showed an improvement in erythema after three sessions of PDL treatment both with and without niacin pretreatment (P = 0·023 and P = 0·009, respectively). There was no significant difference in the improvement of objective erythema between the two sides. However, based on physician assessment the overall clinical improvement on the niacin side was significantly higher (P = 0·005), and patient satisfaction was also higher on the niacin-pretreated side (P = 0·007). There were no remarkable side-effects, with the exception of transient erythema and oedema. CONCLUSIONS Pretreatment with topical niacin safely enhanced the effect of 585-nm PDL treatment of rosacea-associated erythema in Koreans. Application of niacin can be helpful in overcoming the relatively lower effect of subpurpuragenic PDL in dark-skinned Asians.
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Affiliation(s)
- T G Kim
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Sinchon-Dong, Seodaemun-Gu, Seoul, Korea
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Schmitt L, Roos S, Raulin C, Karsai S. [Segmental Darier disease : treatment with pulsed dye laser]. Hautarzt 2010; 60:995-8. [PMID: 19367372 DOI: 10.1007/s00105-009-1732-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Darier disease is often associated with pruritus and an unpleasant odor, causing medical and emotional problems. Ablative laser therapy has proven effective in ameliorating these symptoms. Side effects of this approach include permanent hypopigmentation and a risk of scarring. We present two cases where non-ablative therapy with pulsed dye lasers proved a safe and effective way to manage the intertriginous lesions. Although the mechanism of action is unclear, our success indicates that pulsed dye laser therapy is an option in Darier disease. Larger numbers of patients, ideally in multicenter studies, must be treated in this way to confirm our results.
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Affiliation(s)
- L Schmitt
- Laserklinik Karlsruhe, Kaiserstrasse 104, 76133, Karlsruhe, Deutschland
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KARSAI SYRUS, ROOS SUSANNE, RAULIN CHRISTIAN. Treatment of Facial Telangiectasia Using a Dual-Wavelength Laser System (595 and 1,064 nm): A Randomized Controlled Trial with Blinded Response Evaluation. Dermatol Surg 2008; 34:702-8. [DOI: 10.1111/j.1524-4725.2008.34131.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Galeckas KJ, Ross EV, Uebelhoer NS. A pulsed dye laser with a 10-mm beam diameter and a pigmented lesion window for purpura-free photorejuvenation. Dermatol Surg 2008; 34:308-13. [PMID: 18177402 DOI: 10.1111/j.1524-4725.2007.34063.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND OBJECTIVES In traditional pulsed dye lasers (PDLs), power limitations and pulse characteristics have compromised purpura-free procedures. This study evaluated a new PDL with a modified pulse structure and a 10-mm beam diameter for purpura-free photorejuvenation. A compression handpiece was used for targeting lentigines. MATERIALS AND METHODS Twenty patients with skin types I to III were treated three times at 3- to 4-week intervals. The first pass was delivered through a 10-mm compression handpiece to target pigment dyschromias using fluences between 6.5 and 8.0 J/cm(2) with a 1.5-ms pulse duration. A second pass was then performed with a 10-mm spot with fluences between 9.5 and 10 J/cm(2), a 20-ms pulse duration, and cryogen spray enabled. Improvement was evaluated by comparing pre- and posttreatment photographs and live subjects 1 month after the third treatment. RESULTS In the majority of patients, >90% reduction of fine telangiectasias (<0.6 mm) and dark lentigines was achieved. Pigmented dyschromias improved proportional to the degree of pigment at presentation. Avoidance of purpura with the compression handpiece was dependent on obtaining proper compression before laser emission. Mean textural improvement was 34%. CONCLUSIONS The new 595-nm PDL is highly effective for two-pass purpura-free improvement of telangiectases, pigment dyschromias, and texture.
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Affiliation(s)
- Kenneth J Galeckas
- Department of Dermatology, Naval Medical Center San Diego, San Diego, California 92134, USA.
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Ross EV, Uebelhoer NS, Domankevitz Y. Use of a novel pulse dye laser for rapid single-pass purpura-free treatment of telangiectases. Dermatol Surg 2007; 33:1466-9. [PMID: 18076612 DOI: 10.1111/j.1524-4725.2007.33317.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Purpura-free elimination of telangiectases with a single pass of a pulsed dye laser with a large spot has proved difficult. OBJECTIVE The purpose of this report was to define parameters that achieve single-pass purpura-free telangiectasia reduction. MATERIALS Thirty patients between the ages of 23 and 78 years were treated with a pulsed dye laser with a 10-mm spot and fluences ranging from 9 to 10 J/cm2. The macropulse width was 20 ms. Each macropulse was composed of eight pulselets. Treatments were carried out over facial areas with discrete telangiectases. RESULTS Smaller telangiectases (<600 microm) showed transient bluing followed by stenosis. Larger vessels (600-10,000 microm) showed bluing but inconsistent closure. A second pass typically resulted in closure. CONCLUSION A modified pulsed dye laser was capable of single-pass purpura-free reduction with a 10-mm spot size.
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Uebelhoer NS, Bogle MA, Stewart B, Arndt KA, Dover JS. A Split-Face Comparison Study of Pulsed 532-nm KTP Laser and 595-nm Pulsed Dye Laser in the Treatment of Facial Telangiectasias and Diffuse Telangiectatic Facial Erythema. Dermatol Surg 2007; 33:441-8. [PMID: 17430378 DOI: 10.1111/j.1524-4725.2007.33091.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND OBJECTIVES Pulsed 595 nm and 532 nm lasers can effectively diminish or eliminate facial telangiectasia. We performed a split-face, single-blind, controlled, comparison study in an effort to determine their individual and comparative efficacy. STUDY DESIGN/MATERIALS AND METHODS Fifteen patients were treated using a 595-nm PDL on one side of the face and a pulsed 532-nm potassium-titanyl-phosphate (KTP) laser on the other. Each subject was evaluated at 3 weeks after three treatments. RESULTS Both devices improved telangiectasia. The 532-nm device, however, was at least as effective or more effective than the 595-nm laser in all subjects. On average, the KTP laser achieved 62% clearing after the first treatment and 85% clearing 3 weeks after the third treatment, compared to 49% and 75% for the PDL, respectively. Seventy-nine percent of KTP laser-treated patients continued to have swelling for greater than 1 day versus 71% of PDL-treated patients. Of those patients who noted persistent erythema for at least 1 day after treatment, 58% noted more erythema on the KTP laser-treated side compared to 8% on the PDL-treated side. CONCLUSIONS Both the 595-nm and the 532-nm pulsed lasers are highly effective in the treatment of facial telangiectasia and redness. The 532-nm KTP laser appears to be more effective but causes more swelling and erythema.
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Affiliation(s)
- Nathan S Uebelhoer
- Department of Dermatology, Division of Laser Surgery, Naval Medical Center San Diego, CA 92134, USA.
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Abstract
BACKGROUND Unilateral nevoid telangiectasia (UNT) is a unique vascular dermatosis of ambiguous etiology. The therapeutic role of pulsed dye laser in this condition, especially in individuals with skin types III and IV, has not been elucidated completely. The aim of this study was to assess the response to flash-lamp pulsed dye laser of UNT in Indian patients. METHODS A detailed analysis of nine confirmed cases of UNT patients was undertaken to determine the possible etiologic association of this disease. Six cases were treated with pulsed dye laser in combination with cryogen cooling using the following parameters: spot size, 7 mm; fluence, 5-7.5 J/cm2; wavelength, 585 nm; pulse duration, 450 micros. The procedure was repeated every 4-6 weeks and the response was assessed both clinically and photographically before each session. RESULTS The cases had a mean age of presentation of 20.6 years with an age of onset varying from 2.5 to 23 years. The lesions were located on the head and neck region in four patients, upper limb in four, and lower limb in one. No significant etiologic association could be established. Of the six cases treated with pulsed dye laser, a moderate response (26-50% lightening) was achieved in all cases after a mean of 2.33 sessions, a good response (51-75% lightening) was observed in four patients after 3.25 sessions, and an excellent response (>75% lightening) was found in three patients after 3.66 sessions. Mild and reversible pigmentary alterations occurred in five cases, with mild textural change in one case. There was no scarring. No recurrence was observed. CONCLUSION Pulsed dye laser is a useful modality for treating UNT in Indian patients. Reversible pigmentary changes are the major side-effects.
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Affiliation(s)
- Vinod K Sharma
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India.
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Ruiz-Esparza J. Near [corrected] painless, nonablative, immediate skin contraction induced by low-fluence irradiation with new infrared device: a report of 25 patients. Dermatol Surg 2006; 32:601-10. [PMID: 16706753 DOI: 10.1111/j.1524-4725.2006.32130.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Nonablative radiofrequency (NARF) has been the only method for producing noninvasive skin tightening. Nevertheless, significant pain during the procedure is an important downside of this technology. A new nonablative medical device, Titan (Cutera, Inc., Brisbane, CA, USA), capable of fluences much lower than those possible with NARF, was tested as a less painful alternative. OBJECTIVES To produce skin contraction leading to lifting of eyebrows and/or improvement of lower face and neck skin laxity using fluences below pain levels. PATIENTS AND METHODS Twenty-five patients were treated. Standardized photographs were obtained preoperatively, after a few days, a few weeks, and up to 12 months after the procedure. RESULTS Immediate changes were obtained in 22 of 25 patients. Examination of photographs revealed that the initial improvement was maintained throughout the follow-up period. CONCLUSION Immediate true skin contraction persisting through the immediate, intermediate, and long-term follow-up was found in the vast majority of patients in this group. Edema as an artifact simulating immediate improvement was excluded by serial photographs taken during the follow-up period. Skin contraction occurred at low fluences, below the threshold of pain. This, to the best of our knowledge, has not been previously described in the medical literature.
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Abstract
Lasers and other light sources have been developed that remove or improve many vascular lesions that were previously untreatable. Port-wine stains are the most notable example. Vascular lasers and light sources represent a major advance in dermatology for cosmetic and non-cosmetic applications. This article reviews the common vascular conditions amenable to laser therapy and the approaches and devices used.
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Affiliation(s)
- Chrys Delling Schmults
- Department of Dermatology, University of Pennsylvania Medical Center, 2 Rhoads Pavilion, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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Tan SR, Tope WD. Pulsed dye laser treatment of rosacea improves erythema, symptomatology, and quality of life. J Am Acad Dermatol 2004; 51:592-9. [PMID: 15389196 DOI: 10.1016/j.jaad.2004.04.010] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Persistent erythema and dysesthetic symptoms are typical manifestations of rosacea. OBJECTIVE We sought to assess improvement in erythema, symptoms, and quality of life after pulsed dye laser treatment. METHODS Sixteen patients with erythematotelangiectatic rosacea participated. Spectrophotometric erythema measurements were taken from the right and left malar prominence; chin; and nasal alae, dorsum, and tip. A questionnaire rating the Dermatology Life Quality Index and symptoms of flushing, burning, itching, dryness, swelling, and skin sensitivity was completed. Treatment was undertaken with the pulsed dye laser at purpuragenic fluences. Measurements and treatment were repeated at 8-week intervals for a total of two treatments. RESULTS A statistically significant improvement was observed in symptoms, quality-of-life score, and erythema in all areas with the exception of erythema of the left nasal ala. CONCLUSIONS Pulsed dye laser treatment at purpuragenic fluences is a safe and effective treatment for symptomatic rosacea, resulting in a significant improvement in erythema, symptoms, and quality of life.
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Affiliation(s)
- Stephen R Tan
- Division of Dermatologic Surgery, Indiana University School of Medicine, University of Minnesota, USA.
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